Provider First Line Business Practice Location Address:
2231 S WESTERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90018-1302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-407-2080
Provider Business Practice Location Address Fax Number:
562-407-2080
Provider Enumeration Date:
03/16/2006